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Dialyzer Classification and Mortality in Hemodialysis Patients: A 3-Year Nationwide Cohort Study
- Source :
- Frontiers in Medicine, Vol 8 (2021), Frontiers in Medicine
- Publication Year :
- 2021
- Publisher :
- Frontiers Media SA, 2021.
-
Abstract
- Background: Dialyzers are classified as low-flux, high-flux, and protein-leaking membrane dialyzers internationally and as types I, II, III, IV, and V based on β2-microglobulin clearance rate in Japan. Type I dialyzers correspond to low-flux membrane dialyzers, types II and III to high-flux membrane dialyzers, and types IV and V to protein-leaking membrane dialyzers. Here we aimed to clarify the association of dialyzer type with mortality.Methods: This nationwide retrospective cohort study analyzed data from the Japanese Society for Dialysis Therapy Renal Data Registry from 2010 to 2013. We enrolled 238,321 patients on hemodialysis who were divided into low-flux, high-flux, and protein-leaking groups in the international classification and into type I to V groups in the Japanese classification. We assessed the associations of each group with 3-year all-cause mortality using Cox proportional hazards models and performed propensity score matching analysis.Results: By the end of 2013, 55,308 prevalent dialysis patients (23.2%) had died. In the international classification subgroup analysis, the hazard ratio (95% confidence interval) was significantly higher in the low-flux group [1.12 (1.03–1.22), P = 0.009] and significantly lower in the protein-leaking group [0.95 (0.92–0.98), P = 0.006] compared with the high-flux group after adjustment for all confounders. In the Japanese classification subgroup analysis, the hazard ratios were significantly higher for types I [1.10 (1.02–1.19), P = 0.015] and II [1.10 (1.02–1.39), P = 0.014] but significantly lower for type V [0.91 (0.88–0.94), P < 0.0001] compared with type IV after adjustment for all confounders. These significant findings persisted after propensity score matching under both classifications.Conclusions: Hemodialysis using protein-leaking dialyzers might reduce mortality rates. Furthermore, type V dialyzers are superior to type IV dialyzers in hemodialysis patients.
- Subjects :
- β2-microglobulin clearance
protein-leaking dialyzer
Medicine (General)
medicine.medical_specialty
hemodialysis
business.industry
Proportional hazards model
high-flux dialyzer
medicine.medical_treatment
Mortality rate
Hazard ratio
Subgroup analysis
Retrospective cohort study
General Medicine
mortality
Confidence interval
R5-920
Internal medicine
medicine
Medicine
Hemodialysis
business
low-flux dialyzer
Original Research
Cohort study
Subjects
Details
- ISSN :
- 2296858X
- Volume :
- 8
- Database :
- OpenAIRE
- Journal :
- Frontiers in Medicine
- Accession number :
- edsair.doi.dedup.....e6251a94b3b98e7e5728923eb0c5987b